Combined HPB Volume Protects Hepatectomy Outcomes at Low-Volume Liver Centers
*Susanna W de Geus, *Jian Zheng, *Krista Hachey, *Sing Chau Ng, David McAneny, Teviah E. Sachs, Jennifer F. Tseng
Boston Medical Center, Boston, MA
Objective: This study assesses how the overall volume of hepato-pancreato-biliary (HPB) cancer operations impacts outcomes of liver resection (LR) at low-volume liver surgery centers.
Design: The National Cancer Database (2004-2014) was queried for patients who underwent LR for liver or intrahepatic cancer. Hospital volume was determined separately for all HPB operations and LR. Centers were dichotomized as low- and high-volume centers based upon the national medians. Three study cohort were created: low-volume (LV) centers for both LR and HPB, mixed-volume (MV) centers with low-volume LR but high-volume HPB, and high-volume LR centers (HV).
Setting: Low-volume liver surgery centers
Patients: Patients who underwent LR for liver or intrahepatic cancer
Interventions: Liver resection
Main Outcome Measures: 30-day mortality, positive resection margins rate, and overall survival
Results: Of 8,577 patients identified, 43.7%, 6.8%, and 49.5% patients were treated at LV, MV, and HV centers, respectively. LV hospitals were less likely to have a liver transplant center compared to MV and HV centers (p<0.001). On multivariable analysis, patients treated at LV centers had higher 30-day mortality compared to patients treated at HV centers (Odds Ratio [OR], 1.53; p<0.001). However, patients treated at MV facilities experienced comparable 30-day mortality to HV centers (OR, 0.90; p=0.658). Similar results were found for positive margin rates and overall survival.
Conclusions: Hepatectomy outcomes at low-liver volume centers that nonetheless have substantial experience with HPB cancer operations have outcomes similar to those at high-volume LR centers. Our results demonstrate that the volume-outcome curve for HPB surgery may be assessed more holistically, and that patients may safely receive curative hepatectomy in their chosen centers if HPB volume criteria are met.
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